Serie Internationale Zorgethici 9: Chris Gastmans

1. Where are you working at this moment? I am working as full professor of medical ethics at the Centre for Biomedical Ethics and Law (CBMER) of the Catholic University of Leuven, Belgium. The Centre was created in 1986 (we celebrate the Centre’s 25th anniversary this year) at the medical faculty of our university. The Centre’s staff consists of moral theologians and philosophers, lawyers, nurses and psychologists. At the CBMER philosophical-ethical, empirical-ethical and legal research lines have been developed for reproductive medicine, genetics, biobanks, tissue transplantation, patient rights, end-of-life care and elderly care. We provide courses in medical ethics, healthcare ethics, nursing ethics, and medical law at all faculties of our university. These educational efforts have been translated in an Erasmus Mundus Master in Bioethics.

2. Can you tell us about your research and its relation to the ethics of care? I am in charge of the research lines ‘elderly care ethics’ and ‘end-of-life care ethics’. These two major research lines contain research projects on nurses’ involvement in end-of-life care processes (e.g. euthanasia, withholding/withdrawing artificial food and fluid administration), ethical decision-making regarding physical restraints, intimacy and sexuality in institutionalized elderly, institutional ethics policies on euthanasia, etc. As you can see, all these topics are more or less closely linked to daily care practices. From the beginning of my research activities, I considered care ethics as a promising and innovative ethical perspective from which these care practices can be analyzed. However, as I am convinced that care ethics should go into dialogue with more fundamental theological and philosophical ethical theories, I also consider the personalist approach on ethics as an important source of my ethical thinking. Besides this philosophical-ethical approach to care ethics research, I also conduct empirical ethical studies that help me to understand the essential characteristics of ethically sensitive daily care processes.

3. How did you get involved into the ethics of care? I started my academic work in 1990 at the Centre for Biomedical Ethics and Law in Leuven. I got a doctoral degree in theology in 1995 with a critical study of the historical, anthropological, and moral theological foundations of nursing ethics, conceptualized as an ethics of care. Since 1998, I teach nursing ethics at the nursing department of the medical faculty, medical ethics at the faculty of theology and ethics of care at the faculty of philosophy. Recently, we initiated the international intensive course nursing ethics that will take place on December 7-9 2011 in Leuven. So it is clear that I was involved in the ethics of care from the very beginning of my academic career, both from a research and an educational perspective.

4. How would you define ethics of care? Ethics of care stands for a unique normative perspective from which human behavior can be interpreted and evaluated. In order to have normative power, that is, to be able to distinguish between good and bad behavior, care ethics needs an explicit anthropological basis – a view of mankind that underlies care. This explicit anthropological basis helps us to clarify concepts closely related to care ethics such as vulnerability, interdependence, care, responsibility, relational autonomy, dignity, personhood. Only when the normative anthropological basis of care is sufficiently clarified care practices can be evaluated and optimized from an ethical point of view. I consider this as the main task of care ethicists.

5. What is the most important thing you learned from the ethics of care? The ethics of care provides many ideas that have deepen my insight into the essential characteristics of ethical problems, for instance the central role of vulnerability in human life. But the most important thing I learned from the ethics of care is the emphasis on the contextual embeddedness of ethically sensitive care practices. The role of context in care practices and its impact on the ethical quality of care practices can easily be made visible by empirical research using a qualitative design. For instance, the ethical reasoning of nurses when they are involved in care practices concerning the use of physical restraint in elderly care, is strongly influenced by contextual factors such as workload, time (day-night), architectural characteristics of the ward, communication culture among nurses and physicians. This also shows that the ethical quality of care practices can be improved by considering their contextual embeddedness.

6. Whom do you consider to be your most important teacher(s) in this area? When I was writing my PhD dissertation, I was strongly influenced by the writings of Lawrence Blum. His books ‘Friendship, Altruism and Morality’ (1980) and ‘Moral Perception and Particularity’ (1994) were very useful to clarify for instance the distinction between the virtue of care and emotional involvement. Regarding the personalist approach in ethics, I consider the Leuven moral theologian Louis Janssens as my most important teacher.

7. What works in the ethics of care do you see as the most important? I would recommend the above mentioned books written by Lawrence Blum. But of course, my students are strongly motivated to read the well-known ‘Moral Boundaries’ of Joan Tronto. This book introduced really innovative perspectives in the ethics of care debate.

8. Which of your own books/articles should we read? I would recommend ‘Nursing Considered as Moral Practice: A Philosophical-Ethical Interpretation of Nursing’, published in the Kennedy Institute of Ethics Journal, given that in this article, the main sources of my ethical thinking are brought into dialogue: nursing practice, care ethics, and personalism.

9. What are important issues for the ethics of care in the future?Most criticism towards the ethics of care concerns normativity (see for instance the thematic issue on care ethics in Nursing Ethics 2011 (2)). Hence, I think much more research should be done in order to strengthen the normative foundation of the care ethics approach. Therefore, it might be helpful to enrich care ethics by going into dialogue with the work of important philosophers as Emmanual Levinas, Maurice Merleau-Ponty, Martin Buber and Paul Ricoeur. These philosophers could help us to deepen the normative value of care by referring to its anthropological foundations (e.g. embodiment, intersubjectivity).

10. In Tilburg our ambition is to promote ethics of care nationally and internationally. Do you have any recommendations or wishes? I appreciate the valuable work done by the colleagues in Tilburg. Different from our Centre in Leuven that is located at the medical faculty, the Tilburg care ethicists have very close links with theology and philosophy. I would support the efforts of the care ethicists from Tilburg to provide a sound philosophical and theological foundation for the ethics of care.